dr. jane doe: md

Hi Tumblr. It has been awhile. Apparently it takes a global pandemic for me to slow down and get in touch with hobbies (writing) again. 

It has been:

strange times

unprecedented times

challenging, difficult times!

More than half way through my PGY2 year and experiencing this at least once or twice a call shift.

Had a trauma this past weekend and the whole time I was screaming this in my head. While simultaneously sweating furiously.

Me on the phone to staff: So sorry to bother you, Dr.X, but there was a trauma, a 30-something year old jumped out of a window from a 3-storey building…

Dr.X: Oh no. Poor thing. As in, attempted suicide?

Me: um, no. He was intoxicated and kind of fell out.

Dr.X: Christ. Just another idiot, then.

My last patient I will ever see as a non-radiologist was a patient with second degree burns to his hand. He had accidentally put his hand on his wood stove when he wasn’t paying attention. There was a large blister. I ordered a tetanus shot, dabbed silver sulfadiazine and wrapped it with some gauze. After giving him a note for work (he was in construction and worked a lot with his hands), I sent him on his way. 

And with that, my clinical rotations are finished. 

I’ll miss it a lot, actually. It was such a privilege to work with patients every day- patients with all different types of problems, backgrounds, comorbidities, languages, expectations. It was a privilege to have patients trust you with the most intimate details of their life, their deepest fears or concerns, and having the ability to make them feel better- either with reassurance, or with extra testing if needed. I’ll miss talking to patients every day. I’ll miss examining the patients directly myself, sometimes from head-to-toe, to find the clinical pathology. It made interpreting imaging so much easier, when I had personally examined the patient myself and knew exactly where they were sore, knew exactly what their story was. And I’ll even miss their stories- no matter how circumstantial they were sometimes.   

I’m currently on my last off-service clinical rotation ever (!!!!). It’s the same rotation I had for my last rotation as a medical student before I graduated, which is kind of cute. It’s also quite fitting because it is EM, and I love both rads and EM so much. I have the luxury to self-schedule my shifts at this particular hospital, and I’ve front loaded my shifts quite heavily so I have some time off at the end of the rotation to study anatomy I should already know study before starting my first official radiology rotation. 

I know it’s going to feel great when I have a week and a half off at the end of the month, but it has been pretty tiring to work so many shifts back to back. When I was doing this rotation as a medical student, I worked for 2 weeks in a row so I could get time off for 5 days to go to New Hampshire to hike Mount Washington. That really sucked. Those two weeks were a blur. I feel like I’m doing a lot better this time around, even with the added responsibility of being a resident, because I have actually tried make a conscious effort to have balance. 

I’ve made effort for every shift to do something I enjoy. Whether or not it’s pre-shift or post-shift, I have made plans so I have something to look forward to, or at least spend the day doing something I enjoy before I have to go in for an overnight shift. It sounds so obvious, but it’s made a huge difference for me. When I did these shifts in a row as a med student I just remember feeling like shit and tired, and just talked about how I didn’t want to go in to work. All I could think about was work. By making plans to go hiking during the day before working in the evening, or having plans to go paint pottery with friends after work, I’m still tired, but it’s been really, really nice to have something to look forward to so my thoughts aren’t preoccupied with my day in the emerg department. 

People brush off work-life balance because we’ve all heard it so many times before, but it’s actually so important. It takes conscious effort for me to make plans everyday because it would be so easy for me to lay on the couch and scroll through my phone instead going out and doing stuff. 

I was on call and had to reach a patient that was a 3 hour drive away from our tertiary care centre. I could not for the life of me figure out how to dial long distance from our clinic phone and thought it was easy enough to call the patient from my cellphone, which has free long distance calls. 

Never again.

Not only is it not very professional and crosses some personal-professional life boundaries, but your patient will call you back because now they have your number. In the span of 24 hours I have received a total of seven phone calls from this patient, with 3 voicemail messages when I was in clinic and too busy to pick up my phone. Not only were these calls completely inappropriate, but they were not even related to the problem they were being seen for... or related to medicine.

Patient: can you recommend a hotel for us to stay in while we’re in TeritaryCareCentreCity for the night? Or could you arrange inpatient housing or get us in touch with them?

Not only this, I finished my rotation today and was at my educational half day when the patient proceeded to call me from the waiting room of the clinic to ask how much more of a wait it would be.  

I have been really enjoying my off-service rotations so far. It’s been keeping me busy, but time has flown and I only have 3 more rotations until I go on service.

ICU: wean down vent settings.  

Peds cardio: just ECHO everyone. Musical/harsh/high-pitched murmurs are all bullshit. Your ears lie. ECHO does not. 

Gen surg: don’t fuck with the pancreas. 

Gastroenterology: The liver is a very forgiving organ. Until it is not. 

Neurosurgery: just CT everyone. Neuro exams lie. CT does not. 

Pediatrics: play the phone-tag between all the sub-specialties (admit your own f*ing patients, GI/immunology/respirology)

General Internal Medicine: plan? incentive spirometry and PT/OT. 

Peds Orthopedics: go hide in the library and avoid the 12 hour ORs. 

I was at a lecture once by a radiologist, and she said something that stuck with me:

“We are radiologists second, physicians first.”

I think this applies to all subspecialities in medicine. No matter what you choose to go into after med school and residency, we should remember that we are physicians first. Meaning: there are basics of being a physician that we should be familiar with, such as reading an EKG. How crazy would it be if we consulted cardiology every time the patient needed to be auscultated for heart sounds? Or consulting gyne every time there needed to be a speculum exam? Or calling the radiology hot seat every time a NG is placed? (MTU I’M LOOKING AT YOU). 

I was on GI the other day when we received a consult for query rectovaginal fistula from a neurosurgery floor. It was a young patient who fell off the balcony at a party and now is a paraplegic. The neurosurg resident was wondering if we could see the patient and order the necessary imaging as need. When asked about physical exam findings, he stated he did not do one, but the nurses noted that when they were changing her, they were wondering if there was stool coming from her vagina. When asked about why he didn’t do a physical exam, he stated he did not have a speculum on the floor, and that it was outside his area of expertise. 

Okay. 

1) Do not consult a service without doing a physical exam first. Vagina and anus are very close to one another. Poop from the butt, can look like poop around the vagina, especially if the patient is incontinent. 

2) Like the neurosurgery unit, the GI unit is low on speculum supply. Some basic problem solving will lead to perhaps getting one from the emergency department. Or asking the nurses to find some. Just like the GI service would.

3) This neurosurg R1 has no area of expertise. While technically he’s neurosurg resident, he is an R1. He is less than 1 year out from medical school, where certainly, he must have performed at least one or two speculum exams. 

This gets worse. When I talked to my staff about the ridiculousness of this consult, she hesitantly said: “Well... let’s order a pelvic MRI. It’s been a long time since I did a speculum exam.”

?!?!?!???????????????????????????/

Literally no one has done an exam on this lady. Where is the patient centered care here?? She has absolutely no reason whatsoever to have a fistula from her rectum to her vagina. She has a spinal cord injury, not a genital/colonic one. She did not fall from the balcony and injure her bowel, or did she somehow catch Crohn’s/fistulizing disease on the way down. If ANYONE could just do a speculum exam, or even a pelvic exam to check for the presence of POOP in her VAGINA, we could save so much money on our resources, time and the patient doesn’t have to be claustrophobic in a tight knit scanner. 

Baffled and frustrated, I offered to see her quickly to do a speculum exam. Because it’s definitely not “outside of my area of expertise”, even as a radiology resident. 

I got caught up and busy on doing actually legitimate GI consults that I didn’t have the chance to go up to see her until later that day. When I was on the floor, I ran into her nurse. She told me the patient was gone for her pelvic MRI. GI consult was cancelled.

1) D and I got engaged! I was shocked!

2) We moved! It sucked! Never moving again!

3) We adopted a kitten! My sweet curtain climbing, furniture destroying, nibbly baby:

4) I got my first UTI! 

First week: Hi, I’m J, I’m going to first feel your belly, then listen to your heart, okay?

Fourth week: Are ya ticklish?? Goochie goochie goo! How many belly buttons do you have??? Let’s count!

Lies in pediatric cardiology:

1) I can hear the difference between paradoxical splitting of S2 versus physiological split of S2. 

2) Yes, I can definitely appreciate the 1/6 diastolic murmur at the right upper sternal border. are you fucking kidding me

3) It doesn’t take me 10 tries to find the femoral pulse. I always remember to check the radial femoral delay. 

4) Even though the demon child was screaming and crying, I completed a through physical exam. 

5) Please tell me more about the law of inertia and how that pertains to the vessels. 

Me: So I have a 63 year old man for transfer, admitted with Boerhaave’s, POD 26 esophageal repair and POD 16 for esophageal stent. His sputum grew Candida and he finished his fluconazole therapy 3 days ago. Currently he’s on the ventilator with a trach but otherwise stable. His CT chest abdo pelvis showed his abdominal and mediastinal collections are decreasing, and thoracics is happy to follow up with him at your unit. 

Staff, respirologist: Okay sounds good. Send him over. 

*hangs up*

*pages staff*

Me: ...sorry. I forgot to mention he has a new PE found on CT chest. He’s on an heparin drip.

Staff: ....

Since my last post, I:

wrote my LMCCs crying

went to Brooklyn to shop visit an old friend from undergrad who is currently doing her med school there! 

graduated with my M.D.!!!!!

travelled all around Morocco with my friend/classmate 

found out we passed our LMCCs in a Muslim country during Ramadan... but somehow we managed to find alcohol to celebrate!

And now, tis the last day of my sweet, sweet vacation. I start on ICU tomorrow- whoever thought it would be a good idea to start a new doc on ICU is a sick, sick person. I am scared shitless. I know nothing. 

But for now, let me reminiscence about the last few months...

Grad gala:

NYC:

Morocco: